Vitiligo involves paler, less pigmented patches of skin
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A first-of-its-kind cream that targets the underlying cause of vitiligo will be available from the National Health Service in England. In clinical trials, the cream significantly increased the pigmentation of white skin patches caused by the condition, but with treatment was previously described as controversialbecause vitiligo is neither painful nor dangerous.
“Usually, guys. [with vitiligo] they are asymptomatic in terms of physical symptoms, but it can cause a lot of emotional distress,” she says David Rosemary at Indiana University, who led two studies of the new treatment, ruxolitinib cream.
The cream, which is already available in the US, is sold under the name Opzelura. It treats non-segmental vitiligo, which occurs when symmetrical white patches appear on both sides of the body. It is thought to be caused by the immune system attacking melanocytes, the cells that make the pigment melanin that gives the skin its color.
The treatment is the first drug that has been thoroughly tested that works directly on the pathway that causes vitiligo, he says Emma Rush at Vitiligo Support UK. “Hence this. [recommendation] is such a landmark,” he says.
Ruxolitinib works by inhibiting two enzymes that cause immune cells destroy melanocytes. Existing treatments, such as steroid creams, can restore some pigment but suppress immune function more broadly.
Two attemptspublished in 2022, found that the drug increased pigmentation and reduced the visibility of vitiligo patches compared to a placebo cream. It happened regardless of people’s skin tone (vitiligo is more noticeable on darker skin), and was maintained for at least a year in more than a third of those who stopped using the drug after the trial.
The National Institute for Health and Care Excellence (NICE) considered these results in the past but concluded that ruxolitinib will not be cost effective for use in the NHS. It now says the cream should be made available to people aged 12 and over with non-segmental vitiligo if other topical treatments have not worked or are inappropriate.
Vitiligo which it affects about 1 percent of the world’s populationthey vary in severity. Some people only have a few small spots, while others may have large, red, inflamed or discolored spots.
“Patients and doctors sometimes think we shouldn’t treat vitiligo.” [because] it won’t kill you [and] it’s not painful,” he says Victoria Eleftheriadou in the British Association of Dermatologists. But vitiligo can have serious complications, such as a higher risk depression and anxiety.
Natalie Ambersley – Vitiligo Ambassador for the charity Changing faceswho supports people with physical differences – says people shouldn’t feel judged for treating the condition, but adds that she won’t be seeking ruxolitinib after years of using existing treatments. “I learned to accept my skin,” she says. “We are [all] unique and we can accept the way we look.’
“It’s great that there are people who love the skin they’re in, but it’s not for everyone,” says Rush.
An oral version of ruxolitinib, which is used to treat some cancers and rheumatoid arthritis, has been associated with serious side effectsincluding lymphoma, heart problems and serious infections. But those were not reported with the current version. In two vitiligo studies, ruxolitinib caused only mild side effects, including acne and itching. “There is super minimal systemic absorption,” says Eleftheriadou.
Ruxolitinib is also considered safer than steroid creams, which can cause skin thinning with long-term use. People with severe vitiligo may also be offered ultraviolet therapy, but this is not widely available.
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